Friday, June 8, 2012

March 2, 2012 will live on
forever in my mind as if it were yesterday.
That particular Friday had been my third day in a row to work. I had the same patients all three days so I
felt that I knew them fairly well. I
knew which patients wanted ginger ale with their dinner, what time they wanted
to bathe, and how many times I would have to beg a patient to let me give them
a Lovenox injection before they would give in.
This specific group of four patients were wonderful. As my rule of thumb I try very hard not to
pick favorite patients. Sometimes it
happens unintentionally but I don’t let that fact be known. Mr. X (as he will be called for the remainder
of my story) was one of my unintentional favorites. The day before I sat on his bed as he
recalled multiple stories from his time in the war. He also opened up about his one son and how
much he loved his grandson. Mr. X had
dementia so he quickly forgot that it was his grandson in the room with me or
his great grand-daughter playing on the couch.
He was always pleasant and so thankful for everything.

That Friday Mr. X had slept most
of the morning. This is very common for
him as well as many dementia patients. I
woke him up for lunch and he ate fairly well.
I turned out his lights because he said he was tired. As I was leaving the room he, as always, said
“thank you so much,” and I watched him instantly drift off to sleep. I checked on him periodically throughout the
day and he always said his usual “thank you” as I left. Around 5:00 that evening a doctor wrote an
order to give the patient a now dose of 60 ml Potassium Chloride. For a young patient with a potassium level of
3.4 or even an older patient who was in better condition I would have never
questioned the order; but for a 93 year old patient who wasn’t doing well and
was in a-fib with a potassium level of 3.8 I questioned it. Everything about the order seemed wrong. I asked the charge nurse what she thought I
should do because my gut feeling was don’t give it. She said it was a nursing call that I had to
make but that if it was her she would call the manager and the doctor who wrote
it to clarify the order. So I did just
that. Everyone I spoke with said yes,
give him the potassium. I reluctantly
poured the potassium over orange juice and woke Mr. X up to give it to
him. He swallowed it quickly and drifted
back to sleep, but not before saying “thank you.”

I checked on Mr. X quite often
after giving that dose of potassium. My
gut instinct still told me something was wrong.
So I documented everything I had done in his chart. 6:20 PM: I sat at my desk doing chart checks
and finalizing some paperwork for the day.
I heard the telemetry monitor go off and when I looked at the screen Mr.
X’s heart rate was in the 20s. I ran as
fast as I could down the hall and saw that he was unresponsive and now
asystolic. I immediately began chest
compressions and screamed for someone to grab the crash cart and call a
code. The only person nearby was a night
shift secretary who jumped into action as quickly as she could. We continued CPR until the code team arrived
and took over. It was truly heart breaking
to watch the nurses push countless medications and do thousands of chest
compressions. After about ten minutes the
doctor in the room called it. The team
left the room and it was just Mr. X and me.
I cried. The tears poured out of
my eyes and nothing I could do made them stop.
I didn’t cry for him because he knew where he was going, but I cried for
his family. I cried because I worried
that I didn’t make the right decision in giving the potassium the doctor had
ordered; but deep down I knew that didn’t cause this. When my rational thinking came back into play
I knew it was just his time.

I stayed until 10:00 that night
just to make sure the family had everything they needed. The amazing night shift nurses dressed Mr. X
in the clothes he brought while I did the paperwork. He looked just as if he was taking a
nap. He was peaceful. That night as I was driving home I thought
long and hard about the choices I made that day. I know I made the right ones, and I know it
was his time to meet our maker. I
realized that my gut instinct was telling me something and I now know to always
listen to it. That night I went from
being an RN to becoming a nurse.